Hepatitis B and Liver Transplantation

Liver transplantation was approved for the treatment of decompensated cirrhosis in the United States in 1983. Hepatitis B and hepatitis C viruses are the leading causes of liver transplantation for viral hepatitis and hepatitis B is also an important cause of liver transplantation for fulminant liver failure (also called acute liver failure) due to either acute hepatitis B or an acute exacerbation of chronic hepatitis B. However, until the introduction of hepatitis B immunoglobulin and nucleoside/nucleotide analogues nearly twenty years ago, liver transplantation for hepatitis B was characterized by universal recurrence with a dismal prognosis. At present, liver transplantation for hepatitis B, regardless of whether for decompensated cirrhosis, hepatocellular carcinoma satisfying Milan criteria or acute liver failure has excellent outcomes with results comparable if not better to other liver transplant recipients. This article will review the management of patients with decompensated cirrhosis from HBV prior to liver transplantation, the use of hepatitis B positive donors and the prevention and management of hepatitis B after liver transplantation.